Diabetes has become a serious global social problem, and the diabetes epidemic in China is even more serious. With China’s reform and opening up, rapid economic development, accelerated industrialization and informatization, and significant changes in people’s lifestyles, and with an aging population, these combined effects have led to a yearly increase in the prevalence of diabetes in China. In 2017, the prevalence of diabetes in China was 10.9%, which is higher than the global level.
Over the past 40 years, seven epidemiological surveys on diabetes have been conducted in China, demonstrating a significant increase in the prevalence of diabetes in China year by year. The national prevalence of diabetes was only 0.67% in 1980; 2.51% in 1994; 3.62% in 1996; 4.5% in urban and 1.8% in rural areas in 2002 for people aged 18-44, 44-49, and 60+ years old in urban areas, respectively. In urban areas, the prevalence of diabetes was 2.96%, 4.14%, and 13.13% for people aged 18-44, 44-49, and 60 years or older, respectively, while in rural areas the prevalence was 1.95%, 0.98%, and 7.78% for the corresponding age groups, respectively. In addition, the prevalence of diabetes was more pronounced in large cities than in small and medium-sized cities and rural areas.
In the last decade, the diabetes epidemic in China has become more serious. 2007-2008, the prevalence of diabetes among adults aged 20 years or older was 9.7%, with a total population of 92.4 million people with diabetes, including about 43.1 million in rural areas and 49.3 million in urban areas; and the prevalence of prediabetes was 15.5%, with a total of 148 million people. Of these people with diabetes, 60.7% are undetected and undiagnosed. Also, the prevalence of diabetes and prediabetes increases significantly with age, is significantly higher in men than in women, and is significantly higher in urban than in rural areas.
In 2010, the prevalence of diabetes among more than 90,000 adults aged 18 years or older in 31 provinces and cities in China was 9.65%, slightly higher in men than in women, and significantly higher in urban than in rural areas; less than one third (30.1%) of people with diabetes in China were aware of the disease, only one quarter (25.8%) were treated, and the glycosylated hemoglobin control rate for treated patients was 39.7%.
A retrospective analysis of 2013 data on diabetes in China, with a total of more than 170,000 adults aged 18 years or older, showed a prevalence of 10.9% for diabetes and 35.7% for prediabetes. In addition, there were differences between ethnic groups, with most ethnic minorities having lower prevalence rates compared with the Han Chinese (14.7%), with the Tibetan and Hui populations having the lowest prevalence rates at 4.3% and 10.6%, respectively, significantly lower than the Han Chinese.
Overall, the prevalence of diabetes and prediabetes in China has been on the rise, with the prevalence of diabetes increasing from less than 1% in 1980 to 11% in 2013, especially in recent years when the prevalence has risen sharply and the epidemic has become more severe, and there are also geographic differences, with the Han population having a higher prevalence than ethnic minorities.
The year-to-year rise in diabetes is due to some important changes in the risk factors for diabetes, which are closely related to accelerated urbanization, aging, and rapid economic development. In this environment, people’s lifestyles have changed dramatically, with a marked decrease in physical activity, a change in diet structure, and an increase in the proportion of fat intake.
In terms of physical activity, the number of people with diabetes due to low physical activity was 16.4 million in 1991 and 29.5 million in 2011, and this is expected to continue to increase over the next 20 years. In terms of diet, low intake of whole grains (coarse processed) and high intake of refined grains are the main dietary risk factors.
In addition, obesity is strongly associated with type 2 diabetes, with the prevalence of diabetes among overweight and obese people in China being 12.8% and 18.5%, respectively, higher than the overall population from 2007 to 2008; and 41% of people with type 2 diabetes were overweight, 24.3% were obese, and 45.4% had abdominal obesity (i.e., waist circumference ≥90 cm in men and 85 cm in women). In contrast, 41% of patients with type 2 diabetes were overweight, 24.3% were obese, and 45.4% had abdominal obesity (i.e., waist circumference ≥ 90 cm in men and ≥ 85 cm in women). Although Chinese people are less obese, body fat is more likely to accumulate in the abdominal cavity, forming abdominal obesity. In addition, an aging population and hypertension are important diabetes-prone risk factors.
In conclusion, our country has a high prevalence of diabetes, a large and increasing number, and the highest number of diabetics in the world. Therefore, the joint efforts of the government, individuals, public health institutions and hospitals are needed to prevent and treat diabetes. For the general public, they should actively change their lifestyles and try to cooperate with their doctors for reasonable treatment to reduce the occurrence and development of diabetes.